Health minister to tell B.C. hospitals to tighten control on drugs

The overdose death of a care aide at Vancouver General Hospital proves the need for better methods to detect and prevent theft and abuse of hospital medications, coroner Timothy Wiles said Wednesday. Wiles was investigating the death of Kerri O’Keefe, 36, who had worked in the emergency room for about 15 years, and died in her Surrey condo last summer after injecting a stolen hospital anesthesia drug.

The overdose death of a care aide at Vancouver General Hospital proves the need for better methods to detect and prevent theft and abuse of hospital medications, coroner Timothy Wiles said Wednesday.

Wiles was investigating the death of Kerri O’Keefe, 36, who had worked in the emergency room for about 15 years, and died in her Surrey condo last summer after injecting a stolen hospital anesthesia drug.

Health minister Terry Lake offered his condolences to O’Keefe’s family Wednesday and said he wants all hospitals across the province to adopt “rigorous” policies and procedures.

“It’s important that we take the opportunity to learn from this tragic case and make whatever changes are necessary to improve medication delivery and disposal procedures, to minimize inappropriate narcotic access. And to reduce the chances of this happening again,” Lake said.

Wiles’s report classified O’Keefe’s death as accidental since she was not suicidal in a medical assessment before her death and because she likely didn’t know what drug she was using on the last, fatal occasion as it wasn’t labelled.

O’Keefe had stolen and used hospital narcotics over a period of at least a year but the one that would finally kill her — rocuronium — is a potent anesthesia drug, not a substance of abuse. It paralyzes muscles associated with breathing and without urgent mechanical ventilation support, the drug can cause death, Wiles said. While O’Keefe had a pattern of stealing used syringes that were labelled as containing morphine or fentanyl, she also self-injected drugs in unlabelled syringes, “making it impossible for her to know what substance (like the rocuronium) she was using.”

Vancouver Coastal Health and Fraser Health said Wednesday they’re working on changes to comply with the coroner’s recommendations. And Lake said he’s writing a letter to all health authorities, asking them to ensure their procedures and policies will be just as rigorous as hospitals in the Lower Mainland.

Michele Babich, executive director of Lower Mainland Pharmacy Services, said changes will be multi-faceted, involving more security cameras in hospitals, more locked and automated drug dispensing machines and different biohazard waste bins than the ones O’Keefe stole or emptied into the small suitcase on wheels she routinely took to work.

As well, nurses and doctors will be expected to squirt leftover medications into a slush pail that’s a mixture of all drug residues, instead of leaving remnants of drugs in syringes and other containers when they are discarded.

“We are looking to make these (remaining) drugs un-usable,” Babich said.

Some medical centres squirt leftovers into a bin filled with cat litter to deter anyone from stealing the contents.

Babich said there are 31 hospital pharmacies in the Lower Mainland and even before the O’Keefe case came to light, there were plans to beef up security measures, including Plexiglas barriers and panic alarms, in a bid to deter robberies and internal thefts. Such thefts of narcotics have been steadily rising, according to reports provided to Health Canada by Vancouver Coastal Health and Fraser Health hospitals. In 2013-14, there were 19 narcotic thefts/losses reported; in 2014-15, the number rose to 41 and in 2015-16 there have been 54 reports made to date. VCH officials say the numbers are small, relative to the millions of doses of narcotics given to patients. But it is not known how many reports are not submitted to the federal government.

Babich acknowledged that hospital staff have to be more vigilant about dispensing and disposal of narcotics, which can be highly addictive. Lower Mainland hospitals will also tap into the expertise of the federal Institute for Safe Medication Practices.

Julie Greenall, an Institute spokeswoman, said drug theft and abuse by health professionals and hospital employees is a common problem but her agency has helped many hospitals with theft prevention.

“It’s a highly complex problem,” she said. “Hospital employees can do a lot of things if no one is watching and yet, on the other hand, hospitals have to have a certain level of trust in their employees. Medications are a temptation to some and people who are intent on diverting them will find a way. So you can’t eliminate all opportunities.”

Sharon O’Keefe, Kerri’s mother, said she knows VGH is an “awesome, busy place” but she thinks a lot of Kerri’s colleagues must have had “blinders on.”

O’Keefe said she agrees with the coroner that Kerri’s death was not suicide and knows changes don’t happen overnight.

“But I am hoping something positive comes out of all of this so others don’t lose a child like I have. I’m especially satisfied that the stories in The Vancouver Sun have raised so much awareness.

“VGH is an awesome hospital. But, as the coroner has said, some of their practices and procedures have to be changed.”

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